Developing Integrated Care in Portugal Through Local Health Units

Portugal’s healthcare system, influenced by the Beveridge model, has undergone significant reforms to enhance integration, efficiency, and quality of care. A key initiative in this transformation has been the establishment of Local Health Units (LHUs), which integrate primary and secondary healthcare services within a geographical region. This chapter explores the evolution of LHUs in Portugal, highlighting their role in advancing integrated care through innovative models, including case management, clinical pathways, complex chronic patient support teams, and mental health integration. The chapter presents four case studies demonstrating how LHUs have facilitated multidisciplinary collaboration, improved care coordination, and optimized healthcare resources. The first case study examines a case management program for individuals with complex chronic conditions, which has led to reductions in emergency visits and hospitalizations. The second focuses on clinical pathways for heart failure and multimorbid patients incorporating digital tools for proactive care management. The third discusses a dedicated support team for complex chronic patients, emphasizing personalized care plans and intersectoral collaboration. Lastly, the integration of mental health services within primary and secondary care structures is analyzed, showcasing a shift toward community-based and person-centered mental healthcare. Results indicate that LHUs have contributed to better health outcomes, reduced hospital dependence, and increased patient empowerment. However, challenges such as resistance to change, workforce limitations, and structural barriers remain. The chapter highlights the need for policy alignment, sustainable financing models, and broader replication of successful integration practices to strengthen Portugal’s healthcare system further.